The Association Between Psychodermatological Behaviors, Economic Burden, and Perception of Clinical Severity in Telogen Effluvium: A Cross-Sectional Study

Telogen effluvium (TE) is a type of hair loss that is usually self-limiting but may carry a substantial psychodermatological burden. This study investigated the association between specific self-reported hair loss–related behaviors in patients with TE (delaying hair washing, collecting shed hair) and objective clinical examination findings, as well as their link with the disease-related economic burden. This single-center, cross-sectional study included 110 consecutive patients with primary TE. Patients’ hair loss–related behaviors, the interventions they had used before consulting a physician (over-the-counter supplements, cosmetic products, and procedures such as PRP/mesotherapy), and their information sources were assessed through structured questioning. Objective clinical severity was determined using the Sinclair Shedding Scale and the hair pull test; the disease-related economic burden was determined by proportioning expenditures to the minimum wage. Data were analyzed using the chi-square/Fisher exact test, the Mann-Whitney U test, Spearman correlation, and logistic regression analysis. Among the patients (mean age 27.9 ± 9.5 years), 51.8% had delayed hair washing for fear of shedding, 35.5% had collected their shed hair, and 65.5% reported a fear of going bald. The great majority of patients (86.4%) had resorted to at least one intervention before consulting a dermatologist; the most frequent guiding source was the internet/social media (57.3%). Pull test positivity was significantly higher in patients who delayed hair washing than in those who did not change their washing habits (80.7% vs. 52.8%; p = 0.002). No consistent association was found between patient-reported fear of going bald and the objective Sinclair Shedding Scale. In multivariate logistic regression analysis, the behavior of collecting shed hair was independently associated with high economic burden (adjusted OR = 6.40; 95% CI: 2.19–18.70; p = 0.001). In addition, ferritin levels were significantly lower in patients reporting trichodynia (median 14.0 vs. 32.7 ng/mL; p < 0.001), as were vitamin D levels in patients who frequently performed self–pull tests ( p < 0.001). To the best of our knowledge, this is one of the first studies to quantitatively evaluate psychodermatological behaviors in patients with TE together with objective clinical findings and the disease-related economic burden. The findings suggest that behaviors detectable through simple questioning—such as collecting shed hair and delaying hair washing—are associated both with clinical examination findings and with a higher disease-related economic burden, and may therefore complement the clinician’s overall assessment. In the management of TE, inquiring about these hair loss–related behaviors and protecting patients from unnecessary disease-related economic burden may be beneficial.